Commonwealth Consolidated Regulations

HEALTH INSURANCE REGULATIONS 1975 - REG 19

         (1)   For the purposes of subsection 23DQ (1) of the Act, the following information must be included in a subsection 16B (1) request:

                (a)    the name and either:

                          (i)    the address of the place of practice; or

                         (ii)    the provider number in respect of the place of practice;

                        of the requesting practitioner;

               (b)    the date of the request;

                (c)    a description of the requested diagnostic imaging service;

               (d)    if the requesting practitioner forms an opinion in accordance with subregulation (1B) that the requested diagnostic imaging service is a hospital-related service within the meaning of subregulation (1A) -- the letter 'A'.

      (1A)   In paragraph (1) (d):

"hospital-related service" means:

                (a)    a diagnostic imaging service requested in relation to a person for a condition in relation to which the person will, or is likely to, receive treatment in a hospital facility within 4 weeks of the service being provided, for example, tests performed prior to a person undergoing surgery in a hospital; or

               (b)    a diagnostic imaging service requested in relation to
a person for a condition in relation to which the person had received treatment in a hospital in the 4 weeks immediately before the provision of the service; or

                (c)    a diagnostic imaging service requested in relation to a person, the request for which is made in connection with a condition in relation to which, immediately before receiving the service resulting in the making of the request, the person had presented for treatment to a recognised hospital and was referred or directed to the practitioner who provided that service; or

               (d)    a diagnostic imaging service requested in connection with the provision of a professional service at a recognised hospital in relation to a person who is not admitted to that hospital in connection with the service.

      (1B)   In forming the opinion mentioned in paragraph (1) (d), the practitioner must have regard to the nature of the requested diagnostic imaging service and the circumstances in which the service is to be provided including, but not limited to:

                (a)    the results of any examination by the practitioner of the person in relation to whom the service is to be provided; and

               (b)    the results of any tests in relation to the person conducted by, or made available to, the practitioner; and

                (c)    the history and any other information given to the practitioner by the person; and

               (d)    any letter, form or document given to the practitioner in connection with the provision by the practitioner of a professional service to the person.

         (2)   For the purposes of subregulation (1), a description of the requested diagnostic imaging service must provide, in terms that are generally understood throughout the medical profession, sufficient information to identify the item of the diagnostic imaging services table that relates to the requested service but it need not specify the item number.